Many of the following forms are interactive PDF forms. Please type or print legibly the information into them, print, and obtain signatures.
Forms may be sent via mail, by fax, or scanned and sent via email. Please maintain originals for your files.
60 Community Drive
Augusta, ME 04330
FAX: (207) 624-0166
Billing Information and Enrollment Forms:
- Medical Enrollment/Change Form
- Dental Enrollment/Change Form
- Income Protection Plan Enrollment Form
- Vision Enrollment/Change Form
- Life Enrollment Form
- Life Plan Change Form
- Domestic Partner Affidavit
- Dental Claim Form
- Health Claim Form
- Prescription Claim Form
- Prescription Drug Mail Order Form
- Income Protection Plan (IPP) Claim Form (for Short Term Disability)
- International Claim Form (BlueCard Worldwide)
- Long Term Disability (LTD)
- VSP Vision Out-of-Network Reimbursement Form
To obtain Plan Summaries, please refer to the page for the appropriate benefits program.